My procedures

Endometrial Ablasion and Sterilization – 21 May 2013

What is an endometrial ablation?

Endometrial ablation is a medical procedure that is used to remove or destroy the lining of the uterus (endometrium).

Why ablation?

The lining of the uterus (endometrium) is shed by bleeding each month during a woman’s menstrual period. Sometimes the bleeding is too much or too long and treatment is needed. If bleeding does not respond to medication, your doctor may suggest endometrial ablation. This procedure treats the lining of the uterus to control or stop bleeding. It does not remove the uterus. You should have a clear understanding of your reason for this surgery!

What are the alternatives?

Endometrial ablation is one of several options to manage heavy bleeding. Alternatives would include anti-inflammatory tablets, the oral contraceptive pill, Mirena intra-uterine system and hysterectomy.

How is an ablation performed?

Ablation destroys a thin layer of the lining of the uterus. This stops all menstrual flow in many women. After ablation, some women still have light bleeding or spotting. A few women may have regular periods. This is because the ovaries and uterus are not removed. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Most women are not able to get pregnant after ablation. Thus, if you may want to become pregnant, you should not have an endometrial ablation. Although pregnancy is not likely after ablation, you should take measures to avoid a pregnancy until after menopause. Falling pregnant following an ablation is often complicated with significant risk to the developing baby. Ablation does not affect sexual response.

If you have had a previous caesarean birth an ultrasound will be requested to determine the thickness of the uterine scar and if it will be safe for you to have an ablation.

The procedure is normally performed under local or general anaesthetic in the operating theatre. the doctor will determine your suitability to have the ablation under local anaesthetic according to your previous obstetric and gynaecological history and the examination findings. The cervix is widened (dilated) and a telescope is inserted to look at the internal aspect of the uterus. Your doctor will use one of a number of types of energy to burn away the uterine lining. These may include electrical or thermal (heat) ablation. This procedure does not involve any cuts or stitches to the abdomen. The procedure itself only takes approximately ten minutes, but you can expect to be in theatre and recovery for a number of hours.

What are the risks of undergoing this procedure?

Although the risks associated with ablation are minimal, you should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

  • The procedure may not be able to be completed, due to narrowing of the interior of the cervix. Further surgery may then be necessary.
  • It is possible to make a small hole in the uterus (uterine perforation). In most circumstances this is of no consequence. However, this may require a laparoscopy and/or laparotomy, resulting in a longer hospital stay than expected. In the event of uterine perforation, there is a risk of damage to adjacent organs, such as bowel or bladder, which may require further corrective surgery.
  • In a very few cases, the fluid used to expand your uterus may be absorbed into your bloodstream. This may allow too much fluid in your body and can be serious, causing your hospital stay to be prolonged.
  • Infection could be introduced into the uterus, tubes or abdominal cavity. This would require treatment with antibiotics.
  • Excessive bleeding from the uterus can occur. This may require blood transfusion and further surgery.
  • About one third of women will stop having their periods after an ablation but most women will have lighter periods. Over time, the periods usually return and ablation is often not the best option for women who are many years away from menopause.

There are some general risks inherent to all operations:

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may require treatment with antibiotics and physiotherapy.
  • Clots in the legs with pain and swelling. Rarely part of this clot may break off and go to the lungs which can be fatal.
  • You may suffer a heart attack or stroke because of strain on the heart. Death is an extremely rare possibility for anyone undergoing an operation.

Some women, however, are at an increased risk of complications, including:

  • Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
  • Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

What should I expect after the procedure?

  • You will stay in the recovery room within the theatre suite after the operation while you waken from the anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
  • During your recovery your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital later the same day.
  • You can expect to feel drowsy, have mild nausea and experience some lower abdominal discomfort.
  • For pain control you will be given specific discharge medication if required, but you may use paracetamol with or without codeine (Panadol, Panadeine) as required (one to two tablets every four hours up to a maximum of eight tablets per day).
  • It is also normal to expect a bloody vaginal discharge.
  • Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
  • You should be eating and drinking normally, and be mobilising.

 

Cervical LLETZ – Feb 26, 2013

What is a LLETZ?

LLETZ stands for large loop excision of the transformation zone. This procedure will remove a small segment of the cervix (the lower part of your womb or uterus).

What is a cone biopsy?

A cone biopsy is a less common surgical procedure where a cone-shaped or cylinder-shaped piece of the cervix is removed.

Why are they performed?

These procedures are performed for the diagnosis and treatment of pre-cancerous cells of the cervix. You should have a clear understanding of your reason for this surgery—if not, please ask your doctor.

What are the alternatives?

LLETZ or a cone biopsy are recommended in order to treat pre-cancer cells. If you chose not to undergo treatment, there is a risk that these changes would progress to cancer over some years. If you did not have treatment it would be essential for you to have ongoing close follow-up in the colposcopy clinic.

How are they performed?

The procedure is usually performed under a local anaesthetic. The cervix is examined using a special microscope called a colposcope (in the same way as you were examined in the Gynaecology Clinic). ForLLETZ a fine wire loop charged with electricity is used to shave away the abnormal tissue from the cervix. Because the procedure is so exact, and the loop very thin, very little damage is done to the tissue surrounding the area that needs to be removed. The procedure allows for the blood vessels surrounding the area to be sealed. A cone biopsy may be performed under a local or general anaesthetic. The abnormal cells are often cut out with a knife. Dissolvable sutures are used to stop the bleeding. Both procedures take approximately fifteen minutes.

What are the risks of undergoing this procedure?

Although the risks associated with a LLETZ procedure or a cone biopsy are low, you should be aware that every surgical procedure has some risk.

There are some specific risks to be aware of in relation to this operation:

  • Excessive bleeding from the cervix, which may need blood transfusion or further surgery, either initially or within weeks of the procedure.
  • Infection may be introduced into the cervix, uterus, tubes or abdomen. This may require treatment with antibiotics.
  • Sometimes not all of the abnormal tissue is completely removed, requiring further surgery
  • Uncommonly, the cervix may be weakened by this procedure resulting in a slight increase in the future pregnancy risk of a late miscarriage or preterm birth.
  • Rarely the cervix may be damaged and narrowed leading to painful periods, difficulty in performing adequate pap smears, or problems in the progress of a future labour.

 Papsmear –  Feb 04, 2013

Cervical cancer is one of the most preventable of all cancers and having a Pap smear every two years offers the best chance of early detection. A Pap smear is a screening tool, which can check for early changes in the cells of your cervix; if any changes are found they can be monitored and treated if necessary.

Laparoscopy – Sep 18, 2012

What is a laparoscopy?

A laparoscopy is an operation used to look inside your abdomen. A thin instrument called a laparoscope (similar to a telescope) is inserted through a tiny cut in your belly button to help us examine and operate (if needed) in your abdomen without making large cuts. Laparoscopy is often performed as a day procedure—you don’t have to stay in the hospital overnight.

Why is a laparoscopy performed?

To diagnose certain problems it is necessary to look directly into the abdomen at the reproductive organs. Common reasons for undergoing a laparoscopy include the assessment of painful or heavy periods, pelvic pain (as may occur with endometriosis or adhesions), pelvic masses (such as ovarian cysts) or as assessment of fertility. You should have a clear understanding of your reason for this surgery—if you do not, please ask your doctor.

What are the alternatives?

Similar procedures may be performed by open surgery (laparotomy). This is a much more invasive procedure, involving a higher risk of complications, longer time in hospital and longer recovery after discharge. However, in certain situations a laparotomy may be the most appropriate procedure.

How is laparoscopy performed?

Laparoscopy is normally performed under a general anaesthetic in the operating theatre. Instruments may be inserted into the vagina or rectum to assist in the procedure. A small cut is made in your belly button. The abdomen is inflated with gas and a laparoscope is inserted to look at the internal organs. Further small cuts may be made in your abdomen if any abnormalities require treatment. After the procedure, the instruments are removed, the gas released and the cuts are then closed, with skin glue or with dissolving stitches. The procedure itself takes approximately thirty minutes or more, but you can expect to be in theatre and recovery for a number of hours.

What are the risks of undergoing this procedure?

You should be aware that every surgical procedure has some risk although the risks associated with laparoscopy are minimal.

There are some specific risks to be aware of in relation to this operation:

  • The procedure may not be able to be completed laparoscopically, and you may require an open operation with a larger cut and an increased hospital stay.
  • Deep bleeding may occur inside the abdomen. This may need fluid replacement, blood transfusion or further surgery. It may mean a longer stay in hospital and longer recovery time.
  • Damage to other organs, such as bladder or bowel, which may need further surgery. This may mean a longer stay in hospital and longer recovery time.
  • In rare cases the gas, which is passed into the abdomen, causes heart and chest complications.
  • Infected fluid may collect in the abdominal cavity. This may need surgical drainage and antibiotics.
  • Adhesions (bands of scar tissue) may form and cause bowel obstruction. This can be a short term or a long term complication and may need further surgery.
  • In some people, healing of the wound may be abnormal and the wound can be thickened and red. The scar may be painful.
  • A weakness in the wound may develop into a hernia. This may need further surgery.
  • There is a possibility this procedure may not find the reason for the symptoms you have been experiencing.

There are some general risks inherent to all operations:

  • Small areas of the lungs may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Clots may form in the legs leading to pain and swelling. In rare cases part of this clot may break off and go to the lungs which can be fatal.
  • You may suffer a heart attack or stroke because of strain on the heart.
  • Death is an extremely rare possibility for anyone undergoing an operation

Some women are at an increased risk of complications:

  • Women who are very overweight have an increased risk of wound infection, chest infection, heart and lung complications and blood clots.
  • Smokers have an increased risk of wound and chest infections, heart and lung complications and blood clots.

What should I expect after the procedure?

  • You will stay in the recovery room within the theatre suite after the operation while you wake up from your anaesthetic. You will then be transferred in your bed to the Day Procedure Unit.
  • During your recovery your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure) for several hours after the surgery. As you become fully recovered, these become less frequent but remain regular until you leave hospital later the same day.
  • It is common to feel drowsy, have some abdominal discomfort or bloating, some mild nausea and experience pain on the tip of your shoulder (related to the gas used in the procedure). These symptoms can last from a few hours up to a few days following the operations.
  • You will be provided with pain relief as needed.
  • Your nurse will discuss your follow-up appointment and any discharge arrangements that have been made with you.
  • You should be eating and drinking normally, and be mobilising.

 

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